The mission and strategic plan of the NCCAM includes providing mechanisms that facilitate a pathway to independence for qualified CAM professionals who will become engaged in careers of rigorous CAM research. The candidate's long term objective is to make a transition from the private practice of chiropractic to a full-time research career, investigating the clinical effectiveness of chiropractic and CAM treatments. The K99 post doctoral fellowship portion of this award will provide him with an opportunity to fine tuning his research skills under the guidance of extremely qualified mentors and finish his dissertation research, which will yield important preliminary data for the randomized clinical trial proposed under the ROO portion of this award and prepare him with the skills required to submit his own R01 grant application. The unique "portability" of the 3 year ROO award should facilitate the candidate's career opportunities when applying for tenure track positions at institutions engaged in CAM research, knowing that the candidate brings NIH funding with him, as well as the ability to submit R01 applications for future funding. The candidate proposes for the ROO portion of this award to design and implement a randomized clinical trial comparing the clinical effectiveness of mechanical versus manual manipulation methods for low back pain, using preliminary data obtained from his dissertation research. The relevance of this research to public health is that chiropractors provide the vast majority of spinal manipulation treatments used for the treatment of low back pain, yet there is a paucity of data on the comparison of the different types of spinal manipulation used by chiropractors. The two types of spinal manipulation most commonly used by chiropractors for the treatment of low back are side posture manual manipulation and instruments that deliver a mechanical impulse. The proposed randomized trial will compare these two types of manipulation, and derive data regarding the differences in treatment effect size, reported rates of side effects, and issues regarding dosage (treatment frequency and duration). The candidate anticipates a long career of future research that is dedicated to advancing knowledge about the clinical effectiveness of a wide variety of chiropractic methods for different conditions, giving the public more data on which to make informed health care decisions regarding chiropractic care.